Information Collection

Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10).

IC 34396 under ICR 202007-3235-001 · OMB 3235-0122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3235-0122 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form sec 1696 Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10).	Form
formx-17a-5_2a.pdf www.sec.gov/files/formx-17a-5_2a.pdf	Instruction
sec 1696 FOCUS Report Part IIA formx-17a-5_2f.pdf www.sec.gov/files/formx-17a-5_2f.pdf	Form
SEC 1675 X-17a-5 Schedule I formx-17a-5_schedi.pdf www.sec.gov/files/formx-17a-5_schedi.pdf	Form and Instruction

IC Title:

Report on Income and Expense, Rule 17a-10 (17 CFR 240.17a-10).

Agency IC Tracking Number:

240-154

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 17 CFR 240.17a-10

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	sec 1696	FOCUS Report Part IIA	formx-17a-5_2f.pdf	https://www.sec.gov/files/formx-17a-5_2f.pdf	Yes	No	Printable Only
Instruction			formx-17a-5_2a.pdf	https://www.sec.gov/files/formx-17a-5_2a.pdf	Yes	No	Printable Only
Form and Instruction	SEC 1675	X-17a-5 Schedule I	formx-17a-5_schedi.pdf	https://www.sec.gov/files/formx-17a-5_schedi.pdf	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 46

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	46	8	38
Annual IC Time Burden (Hours)	552	96	456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.